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What Causes Kussmaul Respirations In Dka?

Ketoacidosis In Cats – Causes, Symptoms & Treatment

Ketoacidosis In Cats – Causes, Symptoms & Treatment

Ketoacidosis in cats at a glance Ketoacidosis is a serious complication of diabetes in which ketones and blood sugar levels build up in the body due to insufficient levels of insulin which is required to move glucose into the cells for energy. As a result, the body uses fat as an alternate energy source which produces ketones causing the blood to become too acidic. Common causes include uncontrolled diabetes, missed or insufficient insulin, surgery, infection, stress and obesity. Symptoms of ketoacidosis include increased urination and thirst, dehydration, nausea, diarrhea, confusion, rapid breathing which may later change to laboured breathing. What is diabetic ketoacidosis? Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes characterised by metabolic acidosis (increased acids in the blood), hyperglycemia (high blood glucose) and ketonuria (ketones in the urine). It is caused by a lack of or insufficient amounts of insulin which is required to move glucose from the bloodstream and into the cells to be used for energy. When this occurs, the body begins to search for alternate sources of energy and begins to break down fat. When fat is broken down (metabolised) into fatty acids, waste products known as ketones (acetoacetate, beta-hydroxybutyrate, acetone) are released from the liver and accumulate in the bloodstream (known as ketonemia). This causes the blood to become too acidic (metabolic acidosis). As well as metabolic acidosis, ketones also cause central nervous depression.The body will try to get rid of the ketones by excreting them out of the body via the urine, increased urine output leads to dehydration, making the problem worse. Meanwhile, the unused glucose remains in the bloodstream, resulting in hyperglycemia (high blood sugar).Insulin Continue reading >>

Diabetic Ketoacidosis: What It Is And How To Avoid It

Diabetic Ketoacidosis: What It Is And How To Avoid It

Diabetic ketoacidosis is a life threatening complication. It is common in people with Type 1 Diabetes because their pancreas does not produce insulin. But, it can also happen in individuals with Type 2 Diabetes when their blood sugar reaches critical level. During episodes of DKA, the body runs low on insulin so it burns fats as an alternative energy source. This process produces high level of ketone acids causing the following symptoms: Nausea Vomiting coffee-ground color Excessive thirst and urination Severe abdominal pain which may be cause by pancreatitis, GI tract perforation Kussmaul respiration (a deep and laborious breathing) Confusion Lethargy Dehydration Elevated heart rate (tachycardia) Comatose (severe cases) Blurring of the vision Fruity breath odor Diabetic ketoacidosis has four characteristics that result in the development of the symptoms: hyperglycemia, acidosis, dehydration, and electrolyte imbalance. During hyperglycemia, which causes the blurry vision, the glucose accumulates in the blood. The lack of insulin prevents glucose from entering the cells (hepatic glucose overproduction). The production of counter regulatory hormones such as catecholamines, cortisol, and glucagon, also increases. Gluconeogenesis and glycogenolysis take place. Insulin resistance increases during this stage. This makes it more difficult for the tissues to absorb glucose. The increase in counter-regulatory hormone levels and insulin resistance cause the release of glycerol and fatty acids. The liver starts oxidizing free fatty acids producing high levels of ketone acids. This process leads to ketoanemia. The ketone acids break down into hydrogen ions and ketone anions. The body then tries to bind the hydrogen ions by using up its alkali reserves causing acidosis. To address a Continue reading >>

Causes And Treatment Of Kussmaul Breathing

Causes And Treatment Of Kussmaul Breathing

A condition where patients breathe deeply in a difficult pattern of breathing is known medically as Kussmaul breathing or hyperventilation. The people who are suffering from diseases such as diabetes, kidney dysfunction normally exhibit such form of breathing. In this article we will learn about the causes and treatment of Kussmaul breathing. Legionella Testing Lab - High Quality Lab Results Ad CDC ELITE & NYSDOH ELAP Certified - Fast Results North America Lab Locations legionellatesting.com Learn more Kussmaul Breathing Definition: Deep breathing or hyperventilation is referred as Kussmaul breathing which leads a person to breath in deeply to the point where the level of carbon dioxide falls in the blood. This happens due to the intake of too much oxygen in the body. The similar condition is seen in metabolic acidosis during which a person breathes so quickly which results in shallow breathing ultimately. What does Kussmaul breathing look like? The person suffering from Kussmaul breathing acidosis as a result of such deep breathing gasps for breathing, the condition is known as Kussmaul breathing. Kussmaul breathing is a deep breath of a person with somewhat similar pattern, on the other hand, Cheyne stoke is abnormal breathing pattern where a person breathes deeper and faster. kussmaul breathing sign include increased urged to take a breath along with deep breathing. Some conditions are there which can influence the balance of acids and basis in the body. It means that under different circumstances, body can either turn out to be basic or even acidic. An acidiotic person is the one who is experiencing the process of acidosis prompting to acidemia or unbalanced pH of the body or blood, the condition is known as Kussmaul’s respiration. kussmaul breathing physiology is Continue reading >>

Diabetic Ketoacidosis And Hyperglycaemic Hyperosmolar State

Diabetic Ketoacidosis And Hyperglycaemic Hyperosmolar State

The hallmark of diabetes is a raised plasma glucose resulting from an absolute or relative lack of insulin action. Untreated, this can lead to two distinct yet overlapping life-threatening emergencies. Near-complete lack of insulin will result in diabetic ketoacidosis, which is therefore more characteristic of type 1 diabetes, whereas partial insulin deficiency will suppress hepatic ketogenesis but not hepatic glucose output, resulting in hyperglycaemia and dehydration, and culminating in the hyperglycaemic hyperosmolar state. Hyperglycaemia is characteristic of diabetic ketoacidosis, particularly in the previously undiagnosed, but it is the acidosis and the associated electrolyte disorders that make this a life-threatening condition. Hyperglycaemia is the dominant feature of the hyperglycaemic hyperosmolar state, causing severe polyuria and fluid loss and leading to cellular dehydration. Progression from uncontrolled diabetes to a metabolic emergency may result from unrecognised diabetes, sometimes aggravated by glucose containing drinks, or metabolic stress due to infection or intercurrent illness and associated with increased levels of counter-regulatory hormones. Since diabetic ketoacidosis and the hyperglycaemic hyperosmolar state have a similar underlying pathophysiology the principles of treatment are similar (but not identical), and the conditions may be considered two extremes of a spectrum of disease, with individual patients often showing aspects of both. Pathogenesis of DKA and HHS Insulin is a powerful anabolic hormone which helps nutrients to enter the cells, where these nutrients can be used either as fuel or as building blocks for cell growth and expansion. The complementary action of insulin is to antagonise the breakdown of fuel stores. Thus, the relea Continue reading >>

Kussmaul Breathing, Cheyne-stokes Respiration & Biot's Respiration Terms

Kussmaul Breathing, Cheyne-stokes Respiration & Biot's Respiration Terms

Technical Terms for Respiration There are several weird-sounding terms related to respiration that seem harder to understand than they really are. Actually, their definitions may vary just a bit depending on setting: academic or practical. These are Kussmaul's respiration, Cheyne-Stokes respiration, and Biot's (or Bee-oh's) respiration. It all sounds kind of technical and a bit out there, but, by the end of this lesson, you'll be a pro at explaining what these are. Kussmaul's Respiration There are different medical conditions that can affect the acid/base balance in your body, meaning your body can become more acidic or basic. When a person is acidotic, that is to say they are undergoing a pathological process (known as acidosis) that leads to acidemia, an abnormally low pH of the blood, they may experience Kussmaul's respiration. Kussmaul's respiration, as German physician Adolph Kussmaul himself described, is technically deep, slow, and labored breathing, which we now know is in response to severe acidemia stemming from metabolic acidosis. However, nowadays, it is sometimes used to describe rapid and shallow breathing patterns in cases of less severe acidemia as well. Why does this type of breathing pattern occur? Well, what do you breathe in? Oxygen, right? What do you breathe out? Carbon dioxide. Carbon dioxide is acidic. It lowers the pH of the blood. By breathing rapidly and/or deeply, the body tries to blow off excess CO2 to increase pH back to normal, like an old train engine tries to blow off steam to cool itself off. Such respiration can be seen in patients with diabetic ketoacidosis or renal (that is to say, kidney) failure among other problems. Cheyne-Stokes Respiration The next form of respiration I want to get to is a bit more difficult to understand, but Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

DKA is an acute complication of diabetes mellitus (usually type 1 diabetes) characterized by hyperglycemia, ketonuria, acidosis, and dehydration. Insulin deficiency prevents glucose from being used for energy, forcing the body to metabolize fat for fuel. Free fatty acids, released from the metabolism of fat, are converted to ketone bodies in the liver. Increase in the secretion of glucagon, catecholamines, growth hormone, and cortisol, in response to the hyperglycemia caused by insulin deficiency, accelerates the development of DKA. Osmotic diuresis caused by hyperglycemia creates a shift in electrolytes, with losses in potassium, sodium, phosphate, and water. Serum glucose level is usually elevated over 300 mg/dL; may be as high as 1,000 mg/dL. Serum bicarbonate and pH are decreased due to metabolic acidosis, and partial pressure of carbon dioxide is decreased as a respiratory compensation mechanism. Serum sodium and potassium levels may be low, normal, or high due to fluid shifts and dehydration, despite total body depletion. Urine glucose is present in high concentration and specific gravity is increased, reflecting osmotic diuresis and dehydration. Observe for cardiac changes reflecting dehydration, metabolic acidosis, and electrolyte imbalance- hypotension; tachycardia; weak pulse; electrocardiographic changes, including elevated P wave, flattened T wave or inverted, prolonged QT interval. Administer replacement electrolytes and insulin as ordered. Flush the entire I.V. infusion set with solution containing insulin and discard the first 50 mL because plastic bags and tubing may absorb some insulin and the initial solution may contain decreased concentration of insulin. Continue reading >>

Diabetic Ketoacidosis And Patho

Diabetic Ketoacidosis And Patho

pathophysiology ketogenesis due to insulin deficiency leads to increased serum levels of ketones anad ketonuria acetoacetate, beta-hydroxybutyrate; ketone bodies produced by the liver, organic acids that cause metabolic acidosis respiration partially compensates; reduces pCO2, when pH < 7.2, deep rapid respirations (Kussmaul breathing) acetone; minor product of ketogenesis, can smell fruity on breath of ketoacidosis patients elevated anion gap Methanol intoxication Uremic acidosis Diabetic ketoacidosis Paraldehyde ingestions Intoxicants (salicyclate, ethylene glycol, nipride, epinephrine, norepinephrine) Lactic acidosis (drug induced; didanosine, iron, isoniazid, metformin, zidovudine) Ethanol ketoacidosis Severe renal failure starvation Blood glucose regulation (6) 1. When blood glucose levels rise above a set point, 2. the pancreas secretes insulin into the blood. 3. Insulin stimulates liver and muscle cells to make glycogen, dropping blood glucose levels. 4. When glucose levels drop below a set point, 5. the pancreas secretes glucagon into the blood. 6. Glucagon promotes the breakdown of glycogen and the release of glucose into the blood. (The pancreas signals distant cells to regulate levels in the blood = endocrine function.) Insulin and Glucagon (Regulation) (10) 1. High blood glucose 2. Beta cells 3. Insulin 4. Glucose enters cell 5. Blood glucose lowered 6. Low blood glucose 7. Alpha cells 8. Glucagon 9. Liver releases glucose from glycogen 10. Blood glucose raised What is the manifestations (symptoms) of Type 1? (10) 1. Extreme thirst 2. Frequent urination 3. Drowsiness, lethargy 4. Sugar in urine 5. Sudden vision change 6. Increased appetite 7. Sudden weight loss 8. Fruity, sweet, or wine like odor on breath 9. Heavy, laboured breathing 10. Stupor, unconscious Continue reading >>

Kussmaul Breathing

Kussmaul Breathing

What is Kussmaul Breathing? Kussmaul Breathing is the term given to a condition in which the patient builds up an extremely deep and difficult breathing pattern. This is seen mostly in individuals who are diabetic and have severe forms of metabolic acidosis, particularly diabetic ketoacidosis with kidney dysfunction. Kussmaul Breathing can likewise be clarified as a type of hyperventilation which is a condition in which an individual breathes in such a deep pattern, to the point that the level of carbon dioxide reduces in the blood, which is seen for the most part in metabolic acidosis where the breathing turns out to be more quick and shallow and as the condition exacerbates the breathing gets to be distinctly shallow and profound and it looks as though the individual is virtually gasping for breath. This kind of breathing in which the individual is essentially gasping for air is what is named as Kussmaul Breathing. Kussmaul’s Respiration There are diverse medical conditions that can influence the basic/acidic balance in your body, which means your body can turn out to be more basic or acidic. At the point when a man is acidotic, that is to say they are experiencing a pathological process (known as acidosis) that prompts to acidemia, an abnormal low pH of the blood, they may experience Kussmaul’s respiration. Kussmaul’s respiration, as German doctor Adolph Kussmaul himself portrayed, is in fact profound, slow, and labored breathing, which we now know is because of serious acidemia coming from metabolic acidosis. Nonetheless, these days, it is now and again used to portray shallow and rapid breathing examples in instances of less severe acidemia too. Reasons for this breathing pattern happening All things considered, what do you take in? Oxygen, isn’t that so? W Continue reading >>

(kussmaul's Breathing)

(kussmaul's Breathing)

De Raes EA, Benoit DD, … Decruyenaere JM CONCLUSIONS: Malignant lactic acidosis is a rare and often rapidly fatal metabolic complication if not promptly recognized and treated. An elevated lactic acid concentration, in disproportion with the level of tissue hypoxia, together with high serum LDH are cornerstones in the diagnosis. In contrast to septic shock patients, pronounced polypnea (Kussmaul's breathing pattern) rather than the haemodynamic instability is prominent. Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

4 Evaluation 5 Management Defining features include hyperglycemia (glucose > 250mg/dl), acidosis (pH < 7.3), and ketonemia/ketonuria Leads to osmotic diuresis and depletion of electrolytes including sodium, magnesium, calcium and phosphorous. Further dehydration impairs glomerular filtration rate (GFR) and contributes to acute renal failure Due to lipolysis / accumulation of of ketoacids (represented by increased anion gap) Compensatory respiratory alkalosis (i.e. tachypnea and hyperpnea - Kussmaul breathing) Breakdown of adipose creates first acetoacetate leading to conversion to beta-hydroxybutyrate Causes activation of RAAS in addition to the osmotic diuresis Cation loss (in exchange for chloride) worsens metabolic acidosis May be the initial presenting of an unrecognized T1DM patient Presenting signs/symptoms include altered mental status, tachypnea, abdominal pain, hypotension, decreased urine output. Perform a thorough neurologic exam (cerebral edema increases mortality significantly, especially in children) Assess for possible inciting cause (especially for ongoing infection; see Differential Diagnosis section) Ill appearance. Acetone breath. Drowsiness with decreased reflexes Tachypnea (Kussmaul's breathing) Signs of dehydration with dry mouth and dry mucosa. Perform a thorough neurologic exam as cerebral edema increases mortality significantly, especially in children There may be signs from underlying cause (eg pneumonia) Differential Diagnosis Insulin or oral hypoglycemic medication non-compliance Infection Intra-abdominal infections Steroid use Drug abuse Pregnancy Diabetic ketoacidosis (DKA) Diagnosis is made based on the presence of acidosis and ketonemia in the setting of diabetes. Bicarb may be normal due to compensatory and contraction alcoholosis so the Continue reading >>

What Is Kussmaul Breathing?

What Is Kussmaul Breathing?

Kussmaul breathing is a type of abnormal respiration, characterized by being labored and very deep, that can be seen in patients with extreme metabolic acidosis. This condition is usually identified and treated before Kussmaul breathing develops. Most commonly, this condition is observed in people with diabetic ketoacidosis leading to coma. It is a serious clinical sign and an indicator of the need for immediate medical treatment if it is not already being offered. When patients go into metabolic acidosis, their blood becomes very acidic. The body uses a number of measures to compensate, including respiratory compensation. Patients in the early stages may breathe quickly and shallowly. As the acidosis progresses, Kussmaul breathing can develop. In Kussmaul breathing, patients breathe at a normal or slightly slower rate, but their breaths are much deeper than usual. This is a form of hyperventilation, causing carbon dioxide levels in the blood to drop while oxygen rises. The patient's breathing is also very labored. The patient may sigh and can be obviously seen fighting for breath. Kussmaul breathing is involuntary, spurred by intense air hunger as the body attempts to compensate for the acidosis. The patient may lose consciousness by the point that Kussmaul breathing develops because the body enters a state of crisis in response to the falling pH in the blood. This type of respiration is named for the German physician who first observed it in the 1870s while studying diabetic patients. In patients who have entered metabolic acidosis, it is critical to raise the pH level of the blood to stabilize the patient and then to determine what caused the acidosis so it can be treated. If patients are experiencing difficulty breathing, it is important to make sure the airway rema Continue reading >>

[ketoacidotic Diabetic Metabolic Dysregulation: Pathophysiology, Clinical Aspects, Diagnosis And Therapy].

[ketoacidotic Diabetic Metabolic Dysregulation: Pathophysiology, Clinical Aspects, Diagnosis And Therapy].

Abstract When glucose utilisation is impaired due to decreased insulin effect, ketones are produced by the liver from free fatty acids to supply an alternate source of energy. This adaptation may be associated with severe metabolic acidosis and tends to occur in patients with type I (insulin-dependent) diabetes mellitus. In addition, hypovolemia is an almost invariable finding with marked hypoglycemia and is primarily induced by the associated glucosuria. Ketoacidosis stimulates both the central and peripheral chemoreceptors controlling respiration, resulting in alveolar hyperventilation (Kussmaul's respiration). With the ensuing fall in pCO2 the patient tries to raise the extracellular pH. A fruity odor of acetone on the patient's breath sometimes suggests that ketoacidosis is present. The classical triad of symptoms associated with hyperglycemia are polyuria, polydipsia, and weight loss. Circulatory insufficiency with hypotension is not uncommon due to the marked fluid loss and acidemia. In more severely affected patients, neurologic abnormalities may be seen, including lethargy, seizures or coma. Some patients also have marked vomiting and abdominal pain. The history and physical examination may provide important clues to the presence of uncontrolled diabetes mellitus. Once suspected, the diagnosis can be easily confirmed by measuring the plasma glucose concentration. Glucosuria and ketonuria can be semiquantitatively detected with reagent sticks. Blood gas analysis and anion gap give objective information as to the severity of the metabolic acidosis. Therapy must be directed toward each of the metabolic disturbances: hyperosmolality, ketoacidosis, hypovolemia and potassium, and phosphate depletion. The mainstays of therapy are the administration of low-dose insulin Continue reading >>

Symptoms Of Kussmaul Respirations: Its Causes And Treatment

Symptoms Of Kussmaul Respirations: Its Causes And Treatment

Kussmaul respiration is an abnormal pattern of respiration characterized by deep and hurried breathing. It is one of the most distinctive feature of diabetic ketoacidosis, a serious metabolic complication of diabetes with associated dysfunction of kidneys. Kussmaul breathing causes low level of carbon dioxide in the blood. When the acid content in the blood increases as in metabolic acidosis, diabetic acidosis, or kidney failure, there is increased desire by the patient to breathe deep and rapidly. As a result carbon dioxide saturation in blood decreases. In the beginning, it is shallow and rapid respiration, however, as the condition worsens, it leads to rapid and fast breathing. The patient seems to be gasping for air. This type of abnormal breathing is called Kussmaul respiration. What Causes Kussmaul Respirations? Kussmaul breathing is a condition which results from low level of carbon dioxide in blood. This abnormal form of respiration is commonly seen in people having diabetic ketoacidosis. Kussmaul respiration is deep and fast breathing. Deep breathing and rapid exhalation causes low level of carbon dioxide in the blood leading to hyperventilation. Following conditions can cause kussmaul respiration. Diabetic ketoacidosis: This condition occurs in people suffering from type 1 and type 2 diabetes. It occurs when there is absolute insulin deficiency as in type 1 diabetes or among people with uncontrolled diabetes as in type 2 diabetes. Deficiency of insulin hormone hampers utilization of glucose as an energy source for cellular activity of the muscles and tissues. Body has to rely on fat and protein for energy source instead of glucose, although there is increased circulating glucose in the blood. Breakdown of fat and protein causes release of waste products in the Continue reading >>

Pneumomediastinum As A Complication Of Diabetic Ketoacidosis

Pneumomediastinum As A Complication Of Diabetic Ketoacidosis

To the Editor: I read with interest the Chest Film Clinic on pneumomediastinum by Weinstock, Boiselle, and Roberts in the August issue (What caused this woman's pneumomediastinum? J Respir Dis. 2008;29:314-317). In the discussion of the differential diagnosis, the authors did not mention the occurrence of mediastinal emphysema in diabetic ketoacidosis, which was described in 4 patients by Beigelman and associates1 in 1969. McNicholl and associates2 ascribed the pneumomediastinum to the expiratory effort and grunting associated with ketotic hyperventilation. Munsell3 reviewed 28 cases of spontaneous pneumomediastinum and suggested that an acute transient respiratory obstruction, such as that produced by Valsalva maneuver, cough, emesis, or asthma, was the precipitating factor. Why doesn't mediastinal emphysema develop in a marathon runner during a long-distant run? In this situation, the breathing is normal and brain center–dependent, and it is tapered when the exertion becomes intolerable. (The marathoner is also presumably physically fit and healthy.4) In contrast, in diabetic ketoacidosis, the Kussmaul respiration is involuntary and independent of the respiratory center and abnormally expands lung air spaces, causes alveolar rupture, and results in pneumothorax. As the pulmonary and intrathoracic pressures increase, the extra-alveolar air slips through the periadventitial tissue to the mediastinum, subcutaneous tissue, and other anatomic areas. The incidence of pneumomediastinum complicating diabetic ketoacidosis is low.5-18 Cases are still anecdotal and are sporadically published as one or a few case reports; they are most likely underestimated because the symptom of breathlessness tends to be overshadowed by hyperventilation in diabetic ketoacidosis. Occasionally, Continue reading >>

Diabetic Ketoacidosis: Evaluation And Treatment

Diabetic Ketoacidosis: Evaluation And Treatment

Diabetic ketoacidosis is characterized by a serum glucose level greater than 250 mg per dL, a pH less than 7.3, a serum bicarbonate level less than 18 mEq per L, an elevated serum ketone level, and dehydration. Insulin deficiency is the main precipitating factor. Diabetic ketoacidosis can occur in persons of all ages, with 14 percent of cases occurring in persons older than 70 years, 23 percent in persons 51 to 70 years of age, 27 percent in persons 30 to 50 years of age, and 36 percent in persons younger than 30 years. The case fatality rate is 1 to 5 percent. About one-third of all cases are in persons without a history of diabetes mellitus. Common symptoms include polyuria with polydipsia (98 percent), weight loss (81 percent), fatigue (62 percent), dyspnea (57 percent), vomiting (46 percent), preceding febrile illness (40 percent), abdominal pain (32 percent), and polyphagia (23 percent). Measurement of A1C, blood urea nitrogen, creatinine, serum glucose, electrolytes, pH, and serum ketones; complete blood count; urinalysis; electrocardiography; and calculation of anion gap and osmolar gap can differentiate diabetic ketoacidosis from hyperosmolar hyperglycemic state, gastroenteritis, starvation ketosis, and other metabolic syndromes, and can assist in diagnosing comorbid conditions. Appropriate treatment includes administering intravenous fluids and insulin, and monitoring glucose and electrolyte levels. Cerebral edema is a rare but severe complication that occurs predominantly in children. Physicians should recognize the signs of diabetic ketoacidosis for prompt diagnosis, and identify early symptoms to prevent it. Patient education should include information on how to adjust insulin during times of illness and how to monitor glucose and ketone levels, as well as i Continue reading >>

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